Provider Demographics
NPI:1922151216
Name:NGUYEN, KIM-NGAN THI (OD)
Entity Type:Individual
Prefix:DR
First Name:KIM-NGAN
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2406
Mailing Address - Country:US
Mailing Address - Phone:267-879-3100
Mailing Address - Fax:
Practice Address - Street 1:2300 E LINCOLN HWY
Practice Address - Street 2:SUITE 281
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1824
Practice Address - Country:US
Practice Address - Phone:215-750-6838
Practice Address - Fax:215-750-6940
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U92300Medicare UPIN